The East Hill is a pub in the area of Wandsworth in south west of London.
Surfer Rosa's cover features a photograph of a topless flamenco dancer, pitched against a wall which displays a crucifix and a torn poster. Simon Larbalestier, who contributed pictures to all of the Pixies albums, decided to build the set because "we couldn't find the atmosphere we wanted naturally." According to Larbalestier, Francis came up with the idea for the cover as he wrote songs in his father's "topless Spanish bar"; Larbalestier added the crucifix and torn poster, and they "sort of loaded that with all the Catholicism." Commenting on the cover in 2005, Francis said, "I just hope people find it tasteful." The cover booklet expands on the theme, and features photographs of the flamenco dancer in several other poses; there are no song lyrics or written content, apart from album credits, in the booklet.
Albini's name does not appear on the original record sleeve. The booklet's photographs were taken one day at a pub opposite the 4AD offices because, according to Larbalestier, "it was one of the few places that had a raised stage".